Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
020-1310-80-000
C o CD c N y I O a ~ • -o c 0 © m c fn O m O w c N M p0 • rn •O C E N c m o ° r c u ~O~~ o O ccmyO O (p N O (0 L V) -0 N y ' N N C 'N C U S E U N Q y C Oa N c N c C C O co C N m X N O 12-0 - O o 'O c c E N O z-a) m m m 3 c o m U. O f9 0 `N V U N 'U O N rn a > > 0.2 B w C O c w ' Q (9 in (6 O ' Z O m v £ Q Z `-m a z a m c O O z d c 7 _ o w tq FZ- r m N Z c E -a 'O 01 M ~ N CL O U~IV7 Q I j O N _ N (n U) • O c ►Irl -a d L L 4 Q c c0i m _ °`Q Z F- Z 'o 4 U Z N Y N 4 72 L N CL m (D co N N O C Q O O C O G a L O o N N cu LO c O co N U) E 0 w O O ~1 H N O~ F- H F- _ N N 4 LO O O O Z O O •+v R ~CL IL CL ~ a ! I o 7 O N ° m m ~ to ~ U v~ 0) CO m m 'C71"'1 N 7 O O m = N In 2' (y O CO ~ ~ rn Q N d Q Z ~s _ x' ' ° N O N OO o f ~ w c I © CC O c O c j m N m iD o a~i c ° n omi °o °o O N N O ° m (n M c N 0O ? CO N LO L7 r 0) O d~ Z L 6 m O O 7 C F' C N 04 • ON .N- O N LO U N 0 E ; U it O I N O O y £ a Z n L • m a y U d d C "~1 2 U a 2 0 N 0 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER SAM MILL FIL- a ADDRESS Q_ px'w ZS z- HyA SpN w 1 S y0 /G SUBDIVISION / CSM9 I-A N'N03 4IA4 c LOT 4 Zr SECTION- -T 2-9 N-R 9 Town of_&ypsoN ST. CROIX COUNTY, WISCONSIN Col-DE-$NL PLAN VIEW HuNrEk SHOW i DGE R D. ERY ING IN 100 FEET OF SYSTEM \ F~ B. M.To'P dF 7 /"Igo r4 PIP E l= loo,oo~ 7S 1 fl? WE 0- I I i _ T ~FDJS~ , s'o~E~ o c s4 ag'XT~2 V If x 1 1 Q 1 I z9 Al ~AP.AC.E `75~ Ge 3h ' E I ' /4, E Ya o NOTE: 1250 C-p[, -,.T- -75-6 S _ aFT TeENCN t S/OPF 3~ Y J SE D R o o A -_1 loss ~I ~ I~B.351' I INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. t `L BENCHMARK: To P of / I k O N t*, NokTH COGNf-2 = / Dv, 00 / 9 ALTERNATE BM: _F0 f' Of 61cc►:. 'r-0uAlPA t Icy NJ S~ `SEPTIC TANK)/ PUMP CHAMBPR / HOLDING TANK INFORMATION 1ZSO 6/I~L Manufacturer: huF- ISF K__ Liquid Capacity: Setback from: Well (p0 House / 9 Other yon To _r1fk /Vc fig Pumpi\ Manufacturer Model# Size Float seperation- Gallons/cycle: - _ Alarm Location----' SOI%ABSORPTION SYSTEM Width: S ' Length 7s Number of trenches Z f Distance & Direction to nearest prop. line: /0 1" To soo7 H Setback from: well: S9 House Zq Other yo ;r 5 T y ~ ELEVATIONS .f. Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off G s U~ Header/Manifold Bottom of system ~4,Existing Grade Final grade DATE OF INSTALLATION: -may, PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations ~,T,. CROI Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary PermitNo.: Permit Holder's Name: MUM, BAH ED City Village `?E Town of: State Plan ID No.: HUDSON CST BM-Elev., Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELE ION DATA TYPE MANUFACTURER CAPACITY STATION BS HI :FS ELEV. Septic Cow- C, 25?> Benchmark/ Dosing Aeration Bldg. Sewer olding St/ W Inlet 8 ~ZI TANK SETBACK INFORMATION St/ Wf Outlet TANK TO P/L WELL BLDG. VentAir Ito ntake ROAD Dt Inlet IA Z 03 Septic ~ w, 1 19t i NA Dt Bottom Dosing NA Heade 7.64 IV 97~ Aeration NA Dist. Pipe 0 Ho ing Bot. System ,21 7s o9.6 PUMP/ SIPHON INFORMATION Final Grade Mangain er Demand Modber M TDH Lriction System TDH Ft e F rcLength Dia. Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Lengt i No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ of < LAW SYSTEM TO P / L BLDG WELL LAKE / STREAM LEAC ufacturer: SETBACK INFORMATION Type0 ht,,,, vc t , CH ER Model System: / (p0~, ~S n UNIT DISTRIBUTION SYSTEM Headerig4d,,, Distribution Pipe(s) x Hole Size x Hole S g Vent To Air ke Length Dia. Length Dia- T Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade stem [Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mu c d /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION:: HHuAdson.12.29.19Wr Wt SS r Lot 25, Hunter Rid/JgfLe~~ Plan revision required? es ❑ No Use other side for additional information. SBD-6710 (R 05/91) Date Inspector's Signature Cert No I~■IL~71i1 SANITARY PERMIT APPLICATION BureaSafetyu o oand ff Building Watteer Systems r 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less Countytr C X than 8 112 x 11 inches in size. s s • See reverse side for instructions for completing this application State Sanitary Permit Number Z59 yy3 The information you provide may be used by other government agency programs heck if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name roperty Location :S 14 M M LL E 1/4sO 1/4,S Z T Z~ N, R/ E( Property Owner's Mailing Address Lot Number Block Number © LSZ-- Z4:" City, State Zip Code Phone Number Subdivision Name or CSM Number II. TYPE F BUILDING: (check one) ❑ State Owned City Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms o Towwn of U OSO }{UN7F- III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo D t? c - 1,3/0- 6"0 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. -New 2_ ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an ____System --------System Tank Only______________ Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 120 Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. '7. Final Grade ~p00 Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Elevation 7!5'0 -7 y Feet Z, Feet VII. TANK Capacity INFORMATION in gallons Total # of Manufacturer's Name Prefab. Site Fiber- Plastic Exper. Gallons Tanks Concrete steel glass App. New Existing structed Tanks Tanks Septic Tank or Holding Tank - ZSO 1 (.t> ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: ( tamps) MP/MPRSW No.: Business Phone Number: 3111 12111AfE 114sj~off I , im,,-~e5 , -49 Z_ Plumber's Address (Street, City, State, Zip Code): ( 'a/ izj'ltlZ/~ /VE ~vQSo N IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issue Issuing Ag t Signature (No mp Approved ❑ OwnerGiven Initial lklt_ Surcharge fee) ~p Adverse Determination / (/T~ X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05/94) DISTRIBUTION: Original to County, One copy To: Safety & Ruildings Division, Owner, Plumber INSTRUCTIONS ' ' • i 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. c r- r >v W o ~ w ~ m tPll _o N i i ~ ~ 11 -61 O o, I ~ J -c Z ~ u ~ ITS fTl j OV (?4 N o m r; 7rj / c 121, NI m D f \ (7 s 0 "I r I ray, i 0 Ire r, O z D TO o I ~t # ~ I I r I i ~ o0 cc\\ N t ~ I r" I ' I y Cf) I I Z -n i CAJ o n~ N low -0 1 (11 M I N ~ I z ch 0 I I p - Z I god n I Q N ~rn O r ri -d r+ v► r,, o z Wiscdnsin Department of Industry, SOIL AND SITE EVALUATION REPORT Pa e of 5 L.P'``)jdr and Human Relations g C,ttision ot3afety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code • COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but '-)T Cf'b t not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION -<A 11h ft uvq GOVT. LOT ' V Lj 1/4 SW 1/4,S 1-2- T Z,' N,R / 9 E (or) W PR ERTY OWN 'S MAILING ADDRESS LOT # BLOCK # S B . NAME OR CS 7 +2ou- - 7. A, ,Aft CITY STATE ZIP CEDE PHONE NUMBER E]CITY EVIL GE OWN NEAREST ROAD i 54016 ( ) {J~ Tdnt N ' LktvL WNew Construction Use P"Ji Residential / Number of bedrooms UNk ( I Addition to existing building j [ Replacement [ J Public or commercial describe Code derived daily flow gpd Recommended design loading rate b bed, gpd/ft20.7 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate 0.7 bed, gpd/ft2 0_ trench, gpd/ft2 Recommended infiltration surface elevation(s) ft as refe5ed to site plan benchmark) Additional design / site considerations &~V/dLU ttTld O~UiL rro~ ~t37- ApppoVpL. Parent material Flood plain elevation, if applicable ft TAN K S - Suitable for system 79SV0 ENTIONAL MOUND I - ROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING U= Unsuitable fors stem U S❑ U S0 U I$1 S❑ U S0 U ❑ S U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence BRoots GPD/ft •3 in. Munsell 11u, Sz. Cont. Color Gr. Sz. Sh. Bed Trench -1 ~ A~l~R 3 ~ ~ S~ ~ m c r ~ c. Lv 2 . S $ ~ ~b- ~ Id`1 t~4 3 SL 1 A, is M ~ w 1 o O ,S Ground $ '/19 1bY 7 Q, el__exx. f r3.Y7 ft. Depth to limiting / f ctQrZ Remarks: Boring # 'Z 8 JZ-33 !Q 4 5 It, M Sb1Z M-ji " c-S j .Z 0.3 8Z 'S2 7.S Y,24 4- SL 1 m sbK rn Y CS Ground ,p elev. Oil~: ft. Depth to limiting ftQr, _ Remarks: CSTName-. Please Print / A CY 0 N4SO ~J Phone: Address: t ) b!~A%6Aj j O u Signal Date: > 2 l Q~ CST Number: ¢4 PROPERTYOWNER J~4/O~Irrrl~fi`K SOIL DESCRIPTION REPORT Page 4--of PARCEL I.D. # Low _ Depth Dominant Color Mottles Texture Structure Consistence Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Boundary Bed Trench •.ri -2 , rr► c r C 5 2 CJ . 0 .S M -sky cs / 0-4 o.s II - 30 /oy,t? 4 Ground er -SZ 7•SY,~ 4 SZ rM s~~' n, r CW A -5 ~fi9~ ft. -117 IdA 4 Depth to limiting f~tor~ 7 . Remarks: Boring # n, cr C5 I Ilk S~Z rnsb~ r► CS 7 .z n3 g_ spy 44 6~7 101 Ground ele 1 t4.1l ft. Depth to limiting factor > /0,0% Remarks: Boring # .,:..:y A d-22 1dy~23 ! ~L, fihcr,! ~S Z 0.4S t of a~ o ~z 4-i-1 Ground elev. 10`x, ~{7ft. Depth to limiting 5 facto j_,, Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: c11n onoND nr nn I&WN k6A 000,c~~~~.sd~~ ~P-6,i PP, _ N o~T19 1JC.►4LC I 30' t'S ~ ~3 J 30' Zl, I i .i STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER 514171 f111Z1-.,!5Z ADDRESS. ESQ X # Z 'L_ Roo S o C.~ w r 5 5(0 / r.. SUBDIVISION / CSM#_ T,~ N Z LOT # S SECTION /2 T Z N-R / W, Town of IJ D 1~~ ST. CROIX COUNTY, WISCONSIN PLAN VIEW EVERYTHING WITHIN 100 FEET OF SYSTEM 41- /y r V -Y WELD ~ I f H a s~ a8'kSC~' S e Al- F R ~ Al qq s` s' ~ o Slt LP 4-J INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tangy; manhole cover. 7 Z BENCHMARK: T e P G / jJ/ ~t A T IV aJ ALTERNATE BM: T v C'~ f ~oU,Vp A T/a t4 ~/S`EPTIC TJ K / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: G(~E/ Liquid Capacity:/60.10 Setback from: Well t-)" House C- Other r X10 ,f/~ Pump: Manufacturer Model# Size Float separation, Gallons/cycle: Alarm Location i :SOIL ABSORPTION SYSTEM Width: S Length (,o d Number of trenches -2_._- Distance & Direction to nearest prop. line: / 5 / TD L-4/.o-ST (aT ~A/,E Setback from: well: House a Other ELEVATIONS Building Sewer_ ST Inlet.T~ (P2 ST outlet PC inlet - PC bottom Pump Of f -z_.~ Header/Manifold Bottom of system Existing Grade i . Final grade _Z_ DATE OF INSTALLATION: PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: 'Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: ❑ City ❑ Village R Town of: State Plan ID No.: P itl ' Nn& 1 Hudson CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: 9600002 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark /C,-). 6D, Dosing Aeration Bldg. Sewer Holding St/ VInlet TANK SETBACK INFORMATION St/ I Outlet p/. Vent TANK TO P/ L WELL BLDG. Airintato ke ROAD Dt Inlet Septic as-~ NA Dt Bottom 1311 Dosing NA Header."~a 13 -117 Aeration NA Dist. Pipe g~' o 9 Holding Bot. System p PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand ~°h dam'"~ MW O PM TDH Lift F tion Syesatem TDH Ft oss Forcemain ength Dia. Fi Dist. To Well SOIL AB'SORPTION SYSTEM BED/TRENCH Width S Length No. Of-~enches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DI NSION SYSTEM TO P/L BLDG WELL LAKE/ST LEACHI anufacturer: SETBACK CH INFORMATION TypeO ~_~C'r o e r. System: -r-rZ OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s)//r x Hole Size x Hole Spacin t To Air Intake Length Dia Length Dia. Spacing d SOIL COVER x Pressure Systems Only xx Mound Or At-Grade tems Only Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: HUdson.12.29.19W NW, SW, Lot 25, HUnter Ridge fI- Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD-6710(R 05/91) Date Inspector's Signature Cert. No. w v~i i~n SANITARY PERMIT APPLICATION Bureau oand f Buiui safety ildinWater System! ing Water 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. cC4 - • See reverse side for instructions for completing this application State sanity Permit Number The information you provide may be used by other government agency programs ❑ Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION Property Owner Name Property Location /vIleLEA X1/45 tC,,;P 1A, S/ Z_ T Z , Nr R/9' E (or4 .Shiv Pro erty Owner's Mailing Address Lot Number Block Number O 2y Z 8r L..._- Z S City, State Zip Code Phone Number Subdivision Name or CSM Number ,AfVP.5 G) / S D/ 1(,381'o)Z7A9f T,+4N e/D JE II. TYPE BUILDING: (check one) ❑ State Owned ❑ Ityage t ON #Nearest Road 3 UNi,4IP_ Public 1 or 2 Family Dwelling - No. of bedrooms ❑ Vllll Town of V05 111. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo Q20 - 1310-800 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church / School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. R[ New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank TankOnly ______________Existing System Existing System _ B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 [,A Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (MinAnch) * /09.3.s• Elevation yS-10 _ Z. 17-51 S, 3 o O - 2s /p9, y9 Feet Feet VII. TANK Capacity in all O s Total # Of Prefab. Site Fiber- Exper. INFORMATION New Existin Gallons Tanks manufacturer's Name Concrete st noted Steel glass Plastic App Tanks Tanks Septic Tank or Holding Tank 000 12 ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature': No Stamps) rzv PRSW No.: Business Phone Number: 'A I/ k r- M MF/_,-- 4i b3 Sbo 3- 5l6q L Plumber's Address (Street, City, State, Zip Code): S o/ 416,1 4 E„EN / G L 1_4 N2 lqu,0_10N W/ IX, COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater assue Issuing A e s) Approved E] Owner Given Initial surcharge Fee) l~ liK_ _ Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD-6398 (R. 05194) DISTRIBUTION: Original to County, One (opy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any ne,.v criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority- 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrato or the State of Wisconsin, Safety and Buildings Division, 608-266-3815- To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwel'ing. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type ofpermit_ Check only one on line A. Complete line B if permit is for tank replacement, reo::nnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information, Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. io N c~.E r ~ t 7-~-~- 2J-~ o/ Vi / Z b M In ~p C N I - y n N `o CIL- Z> JW ~ ~ Nt, N z ; u h r 2 A ` . n p m i A ' cc ~wb oe G 14 ~/~Sy" /dTG/NE /3940 V I ( a C% om^ i I rn I ~°n i _0 m I ~ ~ ~ o O U? ~ 41*1 v i ~ i N m m I N j V) N ~l i b I Z W I O O o 4', H rn LA .n Wisca&isin Department of Industry, SOIL AND SITE EVALUATION REPORT Pa g e of 3 tabor an&4 Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code • COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but IST Cf0 not limited to vertical and horizontal reference (Btg4l; direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location an btan4e 'ttle r . ad. _ REVIEWED BY DATE APPLICANT INFORMATION-PLE NT ALL IN TION PROPERTY OWNER: t' i~-~-„~ s ~ PROPERTY LOCATION VGOVT. LOT ' V Lj 1/4 SW 1/4,S j,2_ T jll N,R t 9 E (or) W PROPERTY OWN S MAILING ADDR 0 LOT # BLOCK # S B . NAME OR CS 1 7IROa>z a. 25Aua►tF CITY STATE Z E P ❑CITY ❑VI GE OWN NEAREST ROAD ► S40 Gk`~' M'" Ti414 A) IVY Ll(NL mer jNew Construction Use [1( Reside ' N rtrof s t,INI,Z [ ] Addition to existing building j ] Replacement Public or co... I' escribe Code derived daily flow gpd Recommended design loading rate d .6 bed, gpd/ft20.1 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate O bed, gpd/ft2 Q,$ trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as refer ed to site plan benchmark) Additional design/ site considerations ~V14Ltj►d'T'►b~ hp~ wr Afd't0+26VpL. Parent material Flood plain elevation, if applicable ft S = Suitable for system QQNVENTIONAL MOUND U ROUND ROUND PRESSURE AT-GRADE SY TEM IN FILL HOLDING K AAN U=Unsuitable for system ICI S❑ U S❑ US ❑ U S O U S❑ U ❑ S U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trends k{wl,.. -1~ A~1~2 3 l t m C 1- c w t 6 Fv, /O lay k4 3 SC_ 1 fh s b k M w 1 0 0 ys Ground ~1 J9 ~flY~Q N e~llexx. f 1 ft. Depth to limiting / f~ct~Z Remarks: Boring # Z B ~~-33 !p tj. - 3 r ~ w►sbk n~~r- e5 l Z. X03 ~z -52 Is'YA4 4 5L 1 m -06K nn CS 1 6 Q Ground lOelev. j.-IZ ft. I 5 l' ~,'j ~.B Depth to limiting f If r _ Remarks: CST Name:-Please Print Phone: Address: L1 L A U Signal t~ Date: Z j Q CST Number:G4g4 PROPERTY OWNER -SAAMi41£'Q SOIL DESCRIPTION REPORT Page? o; A PARCEL I.D. # Lg'2S . , Depth Dominant Color Mottles Texture Structure Consistence Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Boundary Bed Trench rh cr C 5 Z CJ .4 0 .S SLY ¢ M C 5 1 D _4 D.S Ground A -SLY- n, r Cw ~ .4 6.5 elev. /fz 9S ft. -~17 J6 4 5 0,7 Depth to limiting ~f~tor~ . Remarks: Boring # d-~ / OYr2 / 5 L Isa e r /h CS Z A S L m 56 es I ,z n.3 g- 1DY~ 4 4 5 ~--7 0 O Ground:.: A,-/2f IOR ele /14:7t ft. Depth to limiting factor > 1b01- Remarks: Boring # A d-2Z 1dy~3 I Yhcr 1 cS z 04 OS tj ok -7 b S-x 4-K-124 MA" Ground elev. 104,47ft. Depth to limiting 5 fact/ O3 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: cnn.oaon~p ncmrn 16w" k6AI B~act,f?,r1{Zk,- 1 SC~4LC I = 30' • SLa P~ 1 / 3~+ 1 I 3o Z? , I I STC-105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERBUYER S 4 /~71 ~I ~I / L L E/L MAILING ADDRESS .8o x ~z 8 z- P u D So N 4_, ?f /G PROPERTY ADDRESS /00 9' /1UN7`,rA_ /O>°E (location of septic system) Please obtain from the Planning Dept. CITY/STATE Iq V O So N w ( 'T' -i/o ~ 1_ 1/4, Section Z_ T Z 9 N-R PROPERTY LOCATION V U-) 1/4, _ 1a TOWN OF 14- VD .6 Q ,'S/ ST. CROIX COUNTY, WI SUBDIVISION TA & YE y ?-1 D 6 C LOT NUMBER ZS' CERTIFIED SURVEY MAP.S3 / 9 ell- , VOLUME 6 9 PAGE LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date. SIGNED: 47---r-21 A-- DATE: St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/ contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property -f" /flleeA i - Location of property Ntt/ 1/4 s a/ 1/4, Section / Z- , TAN-R a-z ?L- Township h<!UD so N Mailing address 36 PyD so" LA-) I ~YDle, Address of site %0657 f/.~jY7'6~2 R/p6E Subdivision name jfAIIVe A10AE Lot no. 2 S Other homes on property? Yes )C No Previous owner of property k,4 NDE t L S ,,4-jVAN Total size of property Z, ©g N e-R~ S Total size of parcel 0 & 2 4 5 Date parcel was created 8 - ,S Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? k Yes No Volume D 31 and Page Number 4/S"G as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that,I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. S'p y~ yt and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. SD y8' SS Signature of App icant Co-Applicant /-/5-946-- Date of Signature Date of Signature DOCUMENT NO. STATE BA F WISCONSI ORM 1-1*M T"Ie w.s ecsa"vso FOR eacoee1ee *ATA " ARRANTY DEED 504855 vot 103J LE 456 r. _ - r ` CISTE4'S OFFICE This Deed, made between Randall W. S]!..n.....an and Patricia E. S nan, i 00 ..................X................... .,ec }brReotM! • husband...and.. Wi fe i Grantor, SEP T 1993 ; and.... Sain- .E....Mi.l-.`er a srile_ QersoR it . 10.45 A:'M a-... Wit~iesseth, That the said Grantor, f r valuable consideration...... Randall W. Synan and Patr~cafa E. Synan St Croix esTU"",o conveys to Grantee the following described real estate' in County, State of Wisconsin: iy Tax Paged No:..».» The SE1/4 of NE1/4 of Section 11; the Sill/4 of NW1/4, the N1/2 7'< of SW1/4, and the South 53 rods (874.5 feet) of the SE1/4 of NW1/4 except the East 74 feet thereof, all in Section 12; all in Township 29 North, Range 19 West, Tovn of Hudson, St. Croix County, Wisconsin. FF~ oA AND Tn ~ A parcel of land located in part of the NE1/4 of SE1/4 of Secti11, Township 29 North, Range 19 West, Torn of Hudson, St. Croix County, Wisconsin further described as follovs: Commencing at the E1/4 corner of said Section 11; thence S89 30100"W, along the North line of the SE1/4 of said Section, 1212.32 feet to the point 'j of :,eginning; thence continuing S89 30100"W, along said North line, 66.00 feet; thence SOO 28103"E, 500.00 feet; thence N89 30100"E, along the North line of Certified Survey Map filed in Vol. "30, Page 722, 38.08 feet; thence N00 11133"W, 150.00 feet; thence N03 58134"E, 351.07 feet to the point of beginning. ,i.$..>Qt.... This . homestead ro rt P pe Y• (is) (u not) Together with all and singular the hereditament& and appurtenances ti,ereunto belonging; And..... R4XXdaxl.._ .!...SYPArt..and..Patr.icia...E-...Synan.......................................................... warrants that the title is good. indefeasible in fee simple and free and clear of encumbrances except easements, restrictions and rights-of-vay of record, if any. s and will warrant and defend the same. i Dated this ...............J.............................. day of A.ug.ust,...................................... , 19..91. a=~~.........~!. ' ~ ~ ~ (SEAL) A0QltL14.^-4 . R F!~t✓. (SEAL) • Randall W. Synan Patricia Synan • eKa ......(SEAL) .............................................................._.....(SEAL) • • AUTBNNTICATION ACKNOWLSDOMBUT S3 Lures STATZ OF WISCONSIN ~ . t ~ ef, y St. Croix sew. authenticated this day of 19...... Peteassilly came before me 1 day of August 19. . the above named , 4 ~l an a . nan,...Patricfa ....»...»_y. TITLE- MEMBER STATE BAR OF WISCONSIN S nan . (If not. 0,~4s ! authorized by 4 708.08. Wis. State.) to me known to be the person .J3..... .Nt he awe ADDITION TO TANNEY RIDGE SPECIAL ADDII IN PART OF THE SW 1/4 OF THE NW 1/4. IN THE NW 1/4 OF THE SW 1/4, AND IN PART OF THE NE 1/4 OF T HE SW 1/4, ALL IN SE( 19W, TOWN OF HUDSON, ST. CROIX COUNTY, WISCONSIN. OWNER 34" NIIIE• V"OFITH IINE OF THE S+'II, OF THE NMII,. SECTION 12 •0. 60• c6E .•110$0%. FI S89.25146•W 984.211 3+016 - 40°.00' Sea. z1 4 h ,31 - g X10. o OT 41 LO 40 In IJ_J?=.a_ i TEQ 2.44 ACRES 6 ACRES i i0 v ,006 50. FT. J (0-T 42 106.124 11, FT. 3 P x.xs ACRES OZO. 31Z'~0 m 020-1312-30 o, 97,651' S0. FT. ~Q JJ It 121 3 zza Na3•°50W .Er►O"A" Cvl.Of-34C 116.53 S 10 WEST - w' ~ 118.33 LOT 43 0,~v Ne3•05'00 ~~13 ACRES i X10,. VY~ 592 SO.iT, i LOTS 39 4i• O I T ( 2.73 ACRES F i 0- Ogj 118.880 0 O N48•351001 1 ° . • 1~i cl • 6s:.~ M 66.00' I ~ 2 I 1/ 0 1 ~ t \ N 3 2- zo\ io S J 1 ! ~pO ' E J706q' P 2 _LA-~ -;y / -=815' ( Lp 38 - / i6 2:;0 ACRES / J• .~ZQ_ 891 SO. FT. W Pv Ot, \2,l"aF 1 a 03 h~. N6j• 1^' ~ N ;L~J W W N far Z- a ~b 4y 4 a 9h 53194: b~• bZ~LOT 37-.-<~, 1q b. 'L \ 2.25 ACR 10 \ !y h~ -13/0 \ b\ , ''g?sW o 9639• gu lirs Will 0 ,r 18 Ta~ T 10~ h2~ ' b• ~jJ n Q ~J s r/r1~rAY 00 A~ ES + e ORES \ P 4.,6 2 SO.fT. 7,1 S0. FT. \L \ 5 ~C a n i 1 l[I {J~ ~I pti zOe Aca6 D 4. \ \ 98.601 SO. FT. ?6.0 /0432C . - a20-1311-90.. opt q 020./3/0 0z 5y ~O I 19 70 26 ACRES g LOT 34 I I S0. FT. \ \ 1 • i 2.61 ACRES a ,~'1 ` s\y.•1`,U . 10. !11/3. DO SO. FT. W .N.• n 6,6.84 © ,p ~.~0~• /'OF,O~~PS~Q`Q~O~~/ 3 ` V1 0 s w.°s ° \ Pao c~~ °~d' . 19 l ~gj0-3~ A A sam uriP= 0ZO LOT 20 4.02 ACRES 175.310 SO-FT _ ---C) moo, \ LOT 3 Z ~n \ \ ` to ACRES ` t~!